锁骨远端骨折块太小、太碎，怎么固定？

锁骨远端骨折采用解剖钢板或钩钢板固定是主流做法，然而对于锁骨远端骨块太小、太碎病例，难以良好复位，即使复位后也难以维持复位，且常规锁定钢板远端锁定孔无法有效把持骨块，使得其治疗仍存在一定挑战。

为解决上述问题，国外学者研究了一种新型钢板，并进行了临床研究，取得良好效果，结果发表在2021.07 JOT期刊上。

Summary（总结）

钢板固定是治疗锁骨远端骨折公认的方法。然而，通常很难用传统的钢板维持远端骨块的复位，尤其是在远端骨块很小或粉碎的情况下。本研究旨在介绍一种技术技巧和临床经验，即使用带抓臂的解剖非锁定板(SCORPION NEO板)治疗不稳定的锁骨远端骨折。在固定过程中，远端骨块被抓臂抓住并用2个螺钉固定。我们回顾了41例使用SCORPION NEO钢板进行不稳定锁骨远端骨折(Neer 2型和5型)内固定的患者。患者被分为两组:不稳定型I（UI），斜方韧带附着于远端骨块，不稳定型II(UII)，斜方韧带附着于从远端骨块分离的第三个碎片。尽管分别在2例(4.9%)、2例(4.9%)、3例(7.3%)、1例(2.4%)和1例(2.4%)患者中观察到延迟愈合、钢板松动、钢板相关疼痛、感染和僵硬；最终随访时所有骨折均愈合。UII组的手术时间明显长于UI组。两组在术后并发症和骨愈合时喙锁距离比方面没有显著差异。我们的结果表明，用带有抓臂的解剖板进行接骨术是一种可行的不稳定锁骨远端骨折的可选治疗，尤其是远端骨块不与斜方韧带相连的情况。

[Introduction: Plate fixation is an established method of treating distal clavicle fractures. However, it is often difficult to maintain the reduction of distal fragments with conventional plates, especially in cases where the distal fragments are small or comminuted. This study aimed to introduce a technical trick and clinical experience of osteosynthesis using an anatomical nonlocking plate with grasping arms (SCORPION NEO plate) for unstable distal clavicle fractures. During fixation, distal fragments are grasped by the plate arms and ixed with 2 screws. We retrospectively reviewed 41 patients who underwent osteosynthesis for unstable distal clavicle fractures (Neer type 2 and 5) using a SCORPION NEO plate. Patients were divided into 2 groups: type unstable 1, where the trapezoid ligament adhered to a distal fragment, and type unstable II (UII), where the trapezoid ligament adhered to a third fragment detached from a distal fragment. Although delayed union, plate loosening, plate-related pain, infection, and stiffness were observed in 2 (4.9%), 2 (4.9%), 3 (7.3%), 1 (2.4%), and 1 patient (2.4%), respectively; all fractures united at the time of final follow-up. Operating time for the UII group was significantly longer than that for the UI group. There were no significant differences between the 2 groups in postoperative complications and coracoclavicular distance ratios at the time of bone union. Our results demonstrated that osteosynthesis with the anatomical plate with grasping arms could be a viable option in the
treatment of unstable distal clavicle fractures, especially in cases where distal fragments are not contiguous with the trapezoid ligament.]

图1：带抓臂的解剖钢板，非锁定

图2：A，模式图；B、C，克氏针固定骨折；D，近端滑动孔置钉；E，依次置入近端、远端螺钉。

图3：钢板固定后，弯曲抓臂，使其环抱远端骨块。

表1：两组术后并发症比较。

总之，该文章提供了一种新型解剖钢板，尤其适用于锁骨远端骨折较小或粉碎病例，尽管该类型钢板未必能真正为我们临床所用，特别是在现有大环境下，仅作为参考。

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